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The United States (US) is experiencing a maternal health crisis, with high rates of maternal morbidity and mortality. The US has the highest rates of pregnancy-related mortality among industrialized nations. Maternal mortality has more than quadrupled over the last decades. Rural areas and minoritized populations are disproportionately affected. Increased pregnancy-care workforce with greater participation from family medicine, greater collaborative care, and adequate postpartum care could prevent many maternal deaths. However, more than 40% of birthing people in the US receive no postpartum care. No singular solutions can address the complex contributors to the current situation, and efforts to address the crisis must address workforce shortages and improve care during and after pregnancy. This essay explores the role family medicine (FM) can play in addressing the crisis. We discuss pregnancy care training in FM residencies as well as the threats posed by financial and medico-legal climates to the maternal health workforce. We explore how collaborative care models and comprehensive postpartum care may impact the maternal health workforce. Efforts and resources devoted to high impact solutions for which FM has considerable autonomy, including collaborative and postpartum care, are likely to have greatest impact. [ABSTRACT FROM AUTHOR]

Context: Health delivery systems are facing increasing calls to develop new ways to address cardiovascular health outcomes, especially in priority populations. Priority populations are those most affected by hypertension (HTN). African Americans, in particular, have the highest prevalence of HTN morbidity and mortality. 1 Researchers have proposed data-integrated interventions as a potentially more effective approach for managing HTN. 2 However, existent research does not adequately address the role of data in HTN management, particularly in primary care and priority populations. Additionally, research has yet to document the different approaches being implemented to improve the management of HTN, focusing on priority populations. Objective: The purpose of this study is to determine how data-driven approaches improve HTN management in priority populations? Specifically, 1) What kinds of approaches exist? 2) How is data driving these approaches? Study Design/Analysis: Systematic Review Setting: Primary care and Family medicine Population Studied: Priority Populations Intervention: Data-driven Interventions Outcome Measures: HTN management Results: We retrieved 521 articles and included 26 articles. The majority of studies implemented a health coaching intervention (n=8). Other included studies implemented a disease management program, best practice alert, clinical decision support, medication management, chronic care model, home BP monitoring, case management, targeted case finding, community health workers, and dashboard intervention. Concerning data utilization, the EHR served three main functions. These were identification, intervention, and monitoring. Studies used EHR to either identify eligible patients, connect multiple components of the primary interventions, or to monitor changes in the target outcomes. Conclusion: This review sheds light on current approaches to HTN management in priority populations. Findings from the review highlight the widespread adoption of a data- centered approach in the management of HTN. We suggest the following next steps for future research: 1) Examine whether differences exist in terms of data quality and effectiveness between data sources used in primary care research and 2) Further explore best practices for data-driven interventions in primary care., Presenters Emmanuel Adediran, MPH, John Stuligross, Cindy Turner, BA, Danielle Forbes, CHES, MPH, Dominik Ose, DrPH, MPH, Robert Owens, [...]

Hypertension disparities persist and remain high among racial and ethnic minority populations in the United States (US). Data‐driven approaches based on electronic health records (EHRs) in primary care are seen as a strong opportunity to address this situation. This qualitative study evaluated the development, sustainability, and usability of an EHR‐integrated hypertension disparities dashboard for health care professionals in primary care. Ten semi‐structured interviews, exploring the approach and sustainability, as well as eight usability interviews, using the think aloud protocol were conducted with quality improvement managers, data analysts, program managers, evaluators, and primary care providers. For the results, dashboard development steps include having clear goals, defining a target audience, compiling data, and building multidisciplinary teams. For sustainability, the dashboard can enhance understanding of the social determinants of health or to inform QI projects. In terms of dashboard usability, positive aspects consisted of the inclusion of summary pages, patient's detail pages, and hover‐over interface. Important design considerations were refining sorting functions, gender inclusivity, and increasing dashboard visibility. In sum, an EHR‐driven dashboard can be a novel tool for addressing hypertension disparities in primary care. It offers a platform where clinicians can identify patients for culturally tailored interventions. Factors such as physician time constraints, data definitions, comprehensive patient demographic information, end‐users, and future sustenance, should be considered before implementing a dashboard. Additional research is needed to identify practices for integrating a dashboard into clinical workflow for hypertension. [ABSTRACT FROM AUTHOR]

Over the years, research regarding the Zika virus has been steadily increasing. Early immunization for ZIKV is a priority for preventing complications such as microencephaly and Guillain–Barré syndrome (GBS). Unlike traditional vaccination approaches, oral dissolving films (ODFs) or mucoadhesive film technology is an emerging, exciting concept that can be used in the field of pharmaceuticals for vaccine design and formulation development. This attractive and novel method can help patients who suffer from dysphagia as a complication of a disease or syndrome. In this study, we investigated a microparticulate Zika vaccine administered via the buccal route with the help of thin films or oral dissolving films (ODFs) with a prime dose and two booster doses two weeks apart. In vitro, the ODFs displayed excellent physiochemical properties, indicating that the films were good carriers for vaccine microparticles and biocompatible with the buccal mucosa. In vivo results revealed robust humoral (IgG, subtypes IgG1 and IgG2a) and T-cell responses (CD4+/CD8+) for ZIKV-specific immunity. Both the Zika MP vaccine and the adjuvanted Zika MP vaccine affected memory (CD45R/CD27) and intracellular cytokine (TNF-α and IL-6) expression. In this study, ZIKV vaccination via the buccal route with the aid of ODFs demonstrated great promise for the development of pain-free vaccines for infectious diseases. [ABSTRACT FROM AUTHOR]

Objective: Current studies have indicated that diabetes mellitus (DM) is highly prevalent in patients with cancer, but there is little research on consequences on the well-being of patients during cancer treatment. This analysis evaluates the relationship between DM and patient-reported outcomes (PRO) in patients with cancer, using a large and well-characterized cohort., Methods: This study utilized the Total Cancer Care protocol at the University of Utah Huntsman Cancer Institute. For this analysis, we integrated data from electronic health records, the Huntsman Cancer Registry, and routinely collected PRO questionnaires. We assessed the association between DM in patients with cancer and PRO scores for anxiety, depression, fatigue, pain interference, and physical function using multiple linear regression and t-tests., Results: The final cohort comprised 3512 patients with cancer, with a mean age of 57.8 years at cancer diagnosis. Of all patients, 49.1% (n = 1724) were female, with 82.0% (n = 2879) patients reporting PROs at least at one time point. Compared with patients who responded, nonresponders were more often female (p = 0.0035), less frequently non-Hispanic White (p = 0.0058), and had a higher BMI (p = 0.0759). Patients with cancer and diabetes had worse PRO scores for anxiety (p = 0.0003), depression (p < 0.0001), fatigue (p < 0.0001), pain interference (p < 0.0001), and physical function (p < 0.0001) compared to patients with cancer without diabetes. Significant associations between diabetes and PRO scores were observed for anxiety (β ± SE: 1.27 ± 0.48; p = 0.0076), depression (β ± SE: 1.46 ± 0.45; p = 0.0011), fatigue (β ± SE: 2.11 ± 0.52; p < 0.0001), pain interference (β ± SE: 1.42 ± 0.50; p = 0.0046), and physical function (β ± SE: -2.74 ± 0.48; p < 0.0001)., Conclusions: The results of this study suggest that patients with cancer and diabetes may be at greater risk for anxiety, depression, fatigue, higher pain interference, and reduced physical function. Strengthening diabetes management is imperative to address the negative impact of diabetes on PROs. In particular, this may be true for patients with skin, breast, prostate, and kidney cancer., (© 2024 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.)